Service Request Form

Name *

Email address *

What type of appliance or HVAC system requires repair?

Please select at least one option.

Refrigerator/Freezer

Wine Cooler

Ice Maker

Oven

Cooktop

Range or Sove

Dishwasher

Washing Machine

Dryer

Furnace

Air Conditioner

Other, please specify

What is the brand of the appliance or HVAC system?

What is the model number of the appliance or HVAC system?

What is the age of the appliance or HVAC system?

What issues are you experiencing with the appliance or HVAC system?

What is your preferred date and time for the service appointment?

What is your address?

Which service or services are you interested in?

Please select at least one option.

Residential Major Appliances Repair

Commercial Appliances Repair

HVAC System Repair and Maintenance

Additional questions or comments

First California Appliance LLC